Birthweight
Guswendy wolas wibowo
27 Agustus
Anamnesis 2015
BB = 1390gr
S = demam (-), muntah (-), merintih (-)
A = sepsis neonatorum
P = cefotaxim 2x75 mg
amikacin 1x20mg
D5 n1/2 160CC (7 TPM)
termoregulasi
cairan oral 100cc/ hari
29 agustus 2015
BB = 1410gr
O = Heart rate 160x/mnt, RR 41x/mnt KU= sedang, gerak aktif, menangis kuat
P = cefotaxim 2x75 mg
amikacin 1x20mg
D5 n1/2 160CC (8 TPM)
termoregulasi
cairan oral 120cc/ hari
o2 per nasal prongs 1 tpm
30 agustus 2015
BB = 1320gr
O = Heart rate 166x/mnt, RR 44x/mnt KU= sedang, gerak aktif, menangis kuat
BB = 1320gr
O = Heart rate 162x/mnt, RR 41x/mnt KU= sedang, gerak aktif, menangis kuat
P =aminofusin 1x20mg
aminofed 1% 60cc/2 jam
aminophylin 1x12 ( setelah 8 jam 3x6 mg )
cefotaxim 2x75 mg
amikacin 3x6mg
D5 n1/2 (9 TPM)
termoregulasi
cairan oral 140cc/ hari ( per sonde 20cc/3 jam )
Hasil lab
BILIRUBIN TOTAL : 7.1 mg/dl
BILIRUBIN DIRECT : 0.4 mg/dl
1 September 2015
BB = 1380gr
O = Heart rate 162x/mnt, RR 41x/mnt KU= sedang, gerak aktif, menangis kuat, o2 terpasang
P =observasi
D10 100cc
Aminofusin 150cc
ASI/PASI 10 cc/ 3 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
2 September 2015
BB = 1310gr
O = Heart rate 162x/mnt, RR 41x/mnt KU= lemas, gerak aktif, menangis kuat, o2 terpasang
A = BBL/BKB/SMK/
Sepsis, apnea of prematurity, post asfiksia berat
P =observasi
D10 120cc
Aminofusin 120cc
ASI/PASI 8 cc/ 3 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
3 September 2015
BB = 1310gr
S = demam (-), muntah (-), merintih (-), sianosis (-), sesak (-) muntah (-), merintih
(-), kejang (-), demam (-) ,wajah kuning (-) BAB/BAK dbn
O = Heart rate 150x/mnt, RR 40x/mnt, continuous murmur (+)
A = BBL/BKB/SMK/
Sepsis, apnea of prematurity, post asfiksia berat, SUSP. PDA
P =observasi
D10 120cc
Aminofusin 120cc
ASI/PASI 8 cc/ 3 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
Konsul bagian jantung
Captopril 3x0.1 mg
Hasil lab
S = demam (-), muntah (-), merintih (-), sianosis (-), sesak (-) muntah (-), merintih
(-), kejang (-), demam (-) ,wajah kuning (-) BAB/BAK dbn
O = Heart rate 152x/mnt, RR 40x/mnt, continuous murmur (+)
A = BBL/BKB/SMK/
Sepsis, apnea of prematurity, post asfiksia berat, PDA+ASD
P =observasi
D10 120cc
Aminofusin 120cc
ASI/PASI 10 cc/ 3 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
Fototherapy per 6 jam
Raber jantung
Captopril 3x0.1 mg
5 September 2015
BB = 1370gr
S = demam (-), muntah (-), merintih (-), sianosis (-), sesak (-) muntah (-), merintih
(-), kejang (-), demam (-) ,wajah kuning (-) BAB/BAK dbn
O = Heart rate 152x/mnt, RR 40x/mnt, continuous murmur (+)
A = BBL/BKB/SMK/
Sepsis, apnea of prematurity, post asfiksia berat, PDA+ASD,
P =observasi
D10 120cc
Aminofusin 120cc
ASI/PASI 10 cc/ 2 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
Fototherapy per 6 jam
Raber jantung
Captopril 3x0.1 mg
6 September 2015
BB = 1490gr
S = demam (-), muntah (-), merintih (-), sianosis (-), sesak (-) muntah (-), merintih
(-), kejang (-), demam (-) ,wajah kuning (-) BAB/BAK dbn
O = Heart rate 152x/mnt, RR 40x/mnt, continuous murmur (+)
A = PDA+ASD
P =observasi
D10 120cc
Aminofusin 120cc
ASI/PASI 10 cc/ 2 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
Raber jantung
Captopril 3x0.2 mg
7 September 2015
BB = 1490gr
S = demam (-), muntah (-), merintih (-), sianosis (-), sesak (-) muntah (-), merintih
(-), kejang (-), demam (-) ,wajah kuning (-) BAB/BAK dbn
O = Heart rate 152x/mnt, RR 40x/mnt, continuous murmur (+)
A = PDA+ASD
P =observasi
ASI/PASI 15 cc/ 2 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
Raber jantung
Captopril 3x0.2 mg
8 September 2015
BB = 1400gr
S = demam (-), muntah (-), merintih (-), sianosis (-), sesak (-) muntah (-), merintih
(-), kejang (-), demam (-) ,wajah kuning (-) BAB/BAK dbn
O = Heart rate 150x/mnt, RR 40x/mnt, continuous murmur (+)
A = PDA+ASD
P =observasi
ASI/PASI 15 cc/ 2 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
Raber jantung
Captopril 3x0.2 mg
9 September 2015
BB = 1380gr
S = demam (-), muntah (-), merintih (-), sianosis (-), sesak (-) muntah (-), merintih
(-), kejang (-), demam (-) ,wajah kuning (-) BAB/BAK dbn
O = Heart rate 150x/mnt, RR 40x/mnt, continuous murmur (+)
A = PDA+ASD
P =observasi
ASI/PASI 15 cc/ 2 jam
Apialys 1x 5 tetes
Maltofer 1x5 tetes
Raber jantung
Captopril 3x0.4 mg
LOW BIRTHWEIGHT ?
Birthweight ?
World Health Organization, International statistical classification of diseases and related health problems,
Definition
United Nations Childrens Fund and World Health Organization, Low Birthweight: Country,regional and global estimates.
UNICEF, New York, 2004.
BIRTH WEIGHT CLASSIFICATION
United Nations Childrens Fund and World Health Organization, Low Birthweight: Country,regional and global estimates.
UNICEF, New York, 2004.
Etiology
1. obstetric complication 2. Medical Complication
A. multiple gestation
B. incompetence
C. PRO ( premature rupture of
membrane )
D. PIH ( pregnancy induce
hypertension ) A. maternal diabetes
E. placenta previa B. chronic hypertension
F. premature history C. tractus urinarius infection
Etiology (2)
Placenta
Genetic
Factor
Comparison of Normal resting
posture small and term babies
Small babies Term babies
World Health Organization.Managing newborn problems: a guide for doctors, nurses, and midwives
Complications
1.75 TO 2.5 KG
Allow the baby to begin breastfeeding . If the baby cannot be
breastfed, give expressed breast milk using an alternative
feeding method. Use Table C-4 to determine the required
volume of milk for the feed based on the babys age.
FEED AND FLUID VOLUMES FOR SMALL BABIES
WITHOUT MAJOR ILLNESS (2)
1.5 TO 1.749 KG
Give expressed breast milk using an alternative feeding method
every three hours according to Table F-3 until the baby is able to
breastfeed.
FEED AND FLUID VOLUMES FOR SMALL BABIES
WITHOUT MAJOR ILLNESS (3)
1.25 TO 1.49 KG
Give expressed breast milk by gastric tube every three hours
according to Table F-4.
Progress to feeding by cup/spoon as soon as the baby can
swallow without coughing or spitting.
FEED AND FLUID VOLUMES FOR SMALL BABIES
WITHOUT MAJOR ILLNESS (4)*
LESS THAN 1.25 KG
Establish an IV line , and give only IV fuid (according to Table
F-5, ) for the first 48 hours.
Give expressed breast milk by gastric tube every two hours
starting on day 3, or later if the babys condition is not yet stable,
and slowly decrease the volume of IV fuid while increasing the
volume of oral feeds according to Table F-5 .
Progress to feeding by cup/spoon as soon as the baby can
swallow without coughing or spitting.
SICK BABIES
1.75 TO 2.5 KG
If the baby does not initially require IV fluid , allow the baby to
begin breastfeeding. If the baby cannot be breastfed, give expressed
breast milk using an alternative feeding method . Determine the required
volume of milk for the feed based on the babys age (Table C-4 )
If the baby requires IV fluid:
- Establish an IV line, and give only IV fuid (according to Table F-6) for
the first 24 hours
- Give expressed breast milk using an alternative feeding method every
three hours starting on day 2, or later if the babys condition is not yet
stable, and slowly decrease the volume of IV fuid while increasing the
volume of oral feeds according to Table F-6.
FEED AND FLUID VOLUMES FOR SMALL BABIES
WITH ILLNESS (2)
1.5 TO 1.749 KG
Establish an IV line,and give only IV fuid (according to Table F-
7) for the first 24 hours.
Give expressed breast milk by gastric tube every three hours
starting on day 2, or later if the babys condition is not yet stable,
and slowly decrease the volume of IV fuid while increasing the
volume of oral feeds according to Table F-7.
Progress to feeding by cup/spoon
as soon as the baby can swallow
without coughing or spitting.
FEED AND FLUID VOLUMES FOR SMALL BABIES
WITH ILLNESS (3)
1.25 TO 1.49 KG
Establish an IV line , and give only IV fuid (according to Table
F-8) for the first 24 hours.
Give expressed breast milk by gastric tube every three hours
starting on day 2, or later if the babys condition is not yet stable,
and slowly decrease the volume of IV fuid while increasing the
volume of oral feeds according to Table F-8.
Progress to feeding by cup/spoon
as soon as the baby can swallow
without coughing or spitting
BREATHING DIFFICULTY
PROBLEMS
The babys respiratory rate is more than 60 breaths per minute.
The babys respiratory rate is less than 30 breaths per minute.
The baby has central cyanosis (blue tongue and lips).
The baby has chest indrawing (Fig. F-3).
The baby is grunting on expiration.
The baby has apnoea (spontaneous cessation of breathing for
more than 20 seconds).
GENERAL MANAGEMENT of BREATHING
DIFFICULITY
Establish an IV line , and give only IV fuid at maintenance volume according to the babys age
for the first 12 hours.
Take a blood sample , and send it to the laboratory for culture and sensitivity, if possible, and to
measure haemoglobin.
If the haemoglobin is less than 10 g/dl (haematocrit less than 30%), give a blood transfusion
If the baby has convulsions, opisthotonos, or a bulging anterior fontanelle, suspect meningitis:
- Treat convulsions, if present
- Perform a lumbar puncture
- Send a sample of the cerebrospinal fuid (CSF) to the laboratory for cell count, Gram stain, culture, and
sensitivity;
- Begin treatment for meningitis while awaiting laboratory confirmation.
If meningitis is not suspected, give ampicillin and gentamicin IV according to the babys age
and weight
SEPSIS (2)